Consultation on Mental Health in Scotland – A 10 Year Vision
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The new Mental Health Strategy will be published in late 2016. It follows a four-year strategy that ran from 2012 to 2015. The new Strategy will cover a 10 year period.
The Scottish Government sought views on their proposed framework and priorities to transform mental health in Scotland.
For more information about the consultation, see https://consult.scotland.gov.uk/mental-health-unit/mental-health-in-scotland-a-10-year-vision
- The table in Annex A sets out 8 priorities for a new Mental Health Strategy that we think will transform mental health in Scotland over 10 years. Are these the most important priorities?
Yes / No / Don’t know
If no, what priorities do you think will deliver this transformation?
Scottish Care recognises the importance of the areas identifies as priorities for the new Mental Health Strategy.
We are particularly pleased to see human rights being given prominence in the new Strategy, given this is the direction of health and social care policy in Scotland. The development of the new National Care Standards seeks to embed a human rights based approach in care service delivery and regulation, as well as commissioning and assessment processes. The new standards will prioritise personal choice, control, equality and inclusiveness in all aspects of an individual’s life and care journey.
What’s more, the independent social care sector (who Scottish Care represents) increasingly values human rights approaches to the provision of high quality, personalised care. This is evidenced through the creation, in 2015 and 2016, of Scottish Care’s Human Rights Conventions for both Care Homes and Care at Home and Housing Support services. These Conventions were developed in partnership with those who access care services and detail what is important to them in the delivery of their care and support. Since the launch of these Conventions, a large number of services and organisations have endorsed them and indicated their commitment to upholding these rights, raising awareness of them and strengthening accountability in relation to the protection and promotion of human rights in care.
Given these developments in health and social care and the increased awareness and embedding of human rights, it is positive to see the priority areas for the Mental Health Strategy equally reflecting this. It is only if different areas of policy and practice are complementary and coherent in their articulation of priorities and approaches that we will see whole systems culture change and reformed practice towards the principles of human rights and improved support for all.
However, Scottish Care is disappointed to see little mention of older people’s mental health needs, particularly those receiving social care, reflected in the priority areas and believes this needs to be remedied.
Scotland’s population projections indicate that the number of people aged 75 and over will increase by 28 per cent from 420,000 in 2012 to 530,000 in 2022 and then continue rising steadily until it reaches 780,000 in 2037 – an increase of 86 per cent in just a quarter of a century and 360,000 more than today. Inevitably, this will mean a higher proportion of those with mental health needs being over the age of 65 and also a higher proportion of these individuals requiring the support of elderly care services.
There are approximately 33,000 older people living in care homes in Scotland any night of the year, and nearly 1,000 other individuals living in care home services for adults with mental health issues. Additionally, 61,500 individuals receive support through home care services, over 50,000 of whom are over the age of 65. Given these figures, it is crucial that we ensure high quality mental health care and support is built into the provision of these services, which nearly 100,000 people across Scotland access. To fail to adequately recognise, plan for and seek to improve the mental health needs and supports for this population through the Strategy would amount to an equalities issue.
Therefore more direction must be given on how we identify the current gaps in support for older people with mental health conditions including social care gaps, how we address these and how we support and train staff in care services to deliver positive outcomes for individuals with mental health conditions, and to promote their own positive mental health.
Scottish Care has identified six areas where we believe more specific attention needs to be paid to mental health priorities for both older people and individuals receiving and working in social care services:
- Recognising mental health conditions in older people as wider than dementia. Whilst dementia is an undoubtedly crucial element of mental health that requires specific planning, it is important to recognise that the spectrum of mental health conditions that an older person may be living with is much wider and these conditions may even be undiagnosed. By narrowing our lens to dementia support only, we risk failing to improve the availability, appropriateness and quality of support for older people living with other conditions, including but not limited to depression, anxiety, eating disorders, bipolar disorder, schizophrenia. The fact that people are living longer does not diminish the range of conditions they may be living with nor the requirement for tailored, effective support to be available to those over 65. Scottish Care and independent sector social care providers are committed to supporting the development and implementation of the next Dementia Strategy, but the Mental Health Strategy offers a complementary yet unique opportunity to better recognise the wide-ranging mental health needs of older people.
- Ensuring appropriate support for those living with enduring mental health conditions who access social care services
One of the current shortcomings of mental health care and support is the way in which both formal and informal support is available to individuals when they start receiving social care services, particularly within a care home setting. For instance, despite the overall success of the commitment to one year post-diagnostic support for individuals with dementia, very few people living in care homes have received this support or even had a formal diagnosis. The current infrastructure and professional relationships between care services, GP services, pharmacy services, Allied Health Professionals and primary care mean, at best, multi-disciplinary support to individuals in care homes settings is a postcode lottery. This has real implications for individuals living with mental health conditions who are likely to require a range of professional supports and particular expertise to enable them to live well in a care home. Additionally, more effective planning needs to be in place to ensure those who have moved into a care home setting can have continuation of community support available to them before they entered the care home. Finally, care home staff do a fantastic job in promoting personalised care to deliver positive outcomes for residents, but there may be additional support and training they need to ensure they fully understand how best to support individuals living with different mental health conditions. The integration of health and social care certainly presents opportunities to improve shared learning, multi-disciplinary and cross-sector working, better professional dialogue and person-centred rather than location-centred care, but this will require culture change which could be progressed more effectively by recognising it through the Strategy.
- Awareness of the risk of developing mental health conditions in periods of transition, change and trauma, particularly in older age
As well as the current challenges around effectively supporting older people with enduring mental health conditions, it is important to recognise the particular factors relating to older people and social care which may prompt or exacerbate mental health conditions. For instance, older people are more likely to experience bereavement through the loss of friends, spouses and relations which can require mental health support. Additionally, individuals who go through transitions such as moving into a care home or another care setting may experience difficulties in adjusting to a loss of home or a perceived loss of identity. It is therefore crucial that we recognise the risk factors and pressure points for older people, where they may require additional expert support in order to maintain or restore positive mental health.
- Transitions between adult services and older peoples services
As articulated in the above two points, there are risks to positive mental health associated with transitional phases and it is recognised that transition phases can lead to a breakdown in communication and quality of care and support, leading to further uncertainty and anxiety for individuals at the centre of that support. In addition to the issues associated with transitions in care settings, there are also challenges where individuals cease to be part of adult services and move to older people’s services. Scottish Care believes that, as a society, we still have an inherent inequity in older people’s care and support compared to other types of care and support and unfortunately, discriminatory practice can still prevail. For instance, we are much more likely to support a younger person in an assets-based, outcomes-focused way which enables them to achieve their goals and ambitions than we are for older people, who are more likely to be identified by their conditions and disabilities rather than their many abilities. Whilst positive progress is being made around outcomes and personalisation, and human rights-based approaches can support this, there remain challenges for how we support older people with mental health needs to live well and what resources (including funding) are available within older people’s services to do this effectively. Attention must therefore be paid to how we support people with mental health needs through care transitions effectively so that they do not experience a diminishing of quality support based on their age or location.
- Capacity of care staff to effectively support people living with mental health conditions
As the population ages and people access care and support services later due to the success of community and informal support, care staff are increasingly supporting individuals at advanced stages of life with more complex and wide-ranging needs. This increasingly includes those living with mental health conditions. Whether individuals are supported in their own homes or in care home settings, care staff need to have the right values, skills, training, awareness and support to enable them to delivery high quality, personalised care that meets the needs and outcomes of the individuals they support. The current funding, recruitment and retention challenges in the care sector make this especially challenging but of even more critical importance, particularly in relation to mental health whereby staff must have the time and resources to deliver sensitive, appropriate support. This can range from recognising subtle changes in an individual’s mood or health through to supporting someone with behaviour that challenges. Often a care worker is the key link to other individuals involved in a person’s life and care, and the quality of relationships built mean they are often best placed to assess the health and wellbeing of the person they support. If we don’t invest in ensuring we understand what care staff need in order to deliver high quality mental health care and support and build this into the Strategy, we will not achieve positive outcomes for individuals.
- Protecting and promoting the positive mental health of those working in social care
A crucial element of the Mental Health Strategy is how we protect and promote the wellbeing of the workforce, particularly those who support others and whose own mental and physical health is often most detrimentally impacted. To understand how best to do this, it is important that we understand the factors and circumstances which can negatively impact on a worker’s mental health. For those working in social care, these elements are wide-ranging and include the impact of dealing with challenging, stressful and emotionally charged situations on a daily basis, long hours and poor pay, delivering palliative and end of life care to individuals with whom relationships and bonds have been formed and subsequently dealing with bereavement, and lone working practices for those in homecare services. Scottish Care recognises the importance of physical, mental and emotional wellbeing of care staff and has held events focused on this issue. The feedback we often receive from front line care staff includes feelings of exhaustion and being close to ‘breaking point’. If further steps are not taken at a national level to embed a focus on workforce wellbeing, we risk a mental health crisis in the social care sector and Scottish Care would therefore want this to be better recognised in the Strategy.
- The table in Annex A sets out a number of early actions that we think will support improvements for mental health. Are there any other actions that you think we need to take to improve mental health in Scotland?
It is positive to see some focus being given to the mental and physical health of workforce through ‘All of Me’. However, steps should be taken to ensure that the workplaces this programme supports includes social care workplaces, and that there is sufficient understanding of the particular challenges for that employers and employees in this sector in relation to mental health as outlined above.
Scottish Care would want to see more explicit actions relating to older people and social care to ensure that real progress is made through the strategy in addressing their mental health care and support provision challenges. Scottish Care would welcome further engagement with the Scottish Government in order that we can support further exploration of what these specific actions may be.
Scottish Care will be commencing a piece of work in early 2017 exploring the unmet mental health needs of older people in receipt of social care services. This work will explore both what these unmet needs are and what needs to be in place to address these gaps, whether they relate to awareness and understanding, care and support availability and appropriateness, or staff capacity, skill mix and training. We would be happy to share the outcome of this work to inform the ongoing development and implementation of the Strategy, but feel that actions specifically around older people and social care need to be built into the initial Strategy to facilitate work, shared learning and improvement support in these vital areas.
- The table in Annex A sets out some of the results we expect to see. What do you want mental health services in Scotland to look like in 10 years’ time?
There are a number of positive outcomes Scottish Care wants to see as a result of the new Mental Health Strategy. These are:
- Equity of access to mental health care and support, regardless of age or mental health condition.
- Recognition of the particular needs of older people living with mental health conditions and an understanding of how best to support these individuals.
- A skilled and valued care workforce who feel confident and competent in effectively supporting people with a range of mental health conditions.
- A culture within health and social care, and wider society, which promotes & protects human rights and recognises mental health and wellbeing as a vital component of overall health and wellbeing.
By ensuring the Strategy is as comprehensive and fit for purpose as it can be (including by using responses to this consultation to refine and improve the Strategy) and by working in partnership with a number of organisations, individuals and sectors throughout its 10 year delivery, we are confident that these results can be achieved.
Policy & Research Manager